Since August 2011, 89,000 children in Pennsylvania have lost their Medicaid coverage, including many with life-threatening illnesses who were mistakenly deemed ineligible. The state currently hasn’t a clue whether many of these children have any healthcare coverage at all.
How did this happen?
In late summer, the Pennsylvania Department of Welfare (DPW) began notifying hundreds of thousands of families by mail that they had ten days to provide necessary documentation in order to keep their children enrolled in Medicaid. If the family missed the deadline—or even if they met it but DPW failed to process the paperwork within the ten days—they were dropped from Medicaid.
Federal law indeed requires that families prove their Medicaid eligibility annually. Pennsylvania requires verification every six months. During the previous administration, under Democratic Governor Ed Rendell, caseloads grew as a result of the recession, while county assistance offices were shorthanded due to budget cuts. Caseworkers simply couldn’t keep pace with the workload and there was a backlog of renewal applications.
Enter Republican Governor Tom Corbett and his anti-spending, anti-government secretary of public welfare, Gary Alexander. They decided to plow ahead with their new approach to eligibility verification: ten days to receive and process the overdue renewals, and an assumption of ineligibility if the applications weren’t reviewed during that time period.
Predictably, the offices couldn’t keep up with the new deluge of mail. It doesn’t seem a stretch to suggest that a Republican administration—hostile to Medicaid—had identified a weakness in the system, exploited it, so that it could reduce spending while bolstering its claim that the system is broken.
Who are some of the victims wronged by the Corbett-Alexander approach to children’s health? A 5-year-old with leukemia; a 2-year-old with a congenital heart disorder; a severely disabled 12-year-old who requires home healthcare; 9-year-old twins, one with autism, the other with a hearing impairment; a 1-year-old with cerebral palsy.
Imagine, a parent of a toddler battling cancer, and suddenly a need to—as one advocate put it—“engage in a Kafkaesque process of getting your kid back on Medicaid.”
What is also deeply disturbing is this: normally when a child is no longer Medicaid-eligible in Pennsylvania parents are referred to the Children’s Health Insurance Program (CHIP), a federally subsidized healthcare program for low-income kids. The state takes great pride in near universal coverage of children—it offered one of the first CHIP programs in the country in 1992. But as advocates watched Medicaid enrollment fall off a cliff—89,000 dropped between August 2011 and January 2012—CHIP enrollment remained flat.
Where the hell are the kids? advocates began to ask.
DPW’s initial explanation was that the 89,000 kids dropped included families that moved out of state or were no longer income-eligible. But, when pressed for an accounting, DPW’s own analysis revealed that the number of families falling within these categories is paltry.
Secretary Alexander also played games with the numbers. As recently as May 1, during an interview on Pennsylvania public radio, he said: “It wasn’t children that were removed, it was families. We call them cases—so that there are parents and children.”
But Pennsylvania Partnerships for Children, a nonpartisan organization dedicated to improving the health, education and wellbeing of children and youth throughout the state, says that simply isn’t true. It points to DPW’s own records, which show that the 89,000 figure represents children dropped from Medicaid.
Secretary Alexander also offered this explanation for the state’s actions: “The problem we have, of course, is that we have federal rules and regulations that we have to follow and we have to do those redeterminations every six months.”
Actually, the problem the secretary has is either ignorance or lying: federal law requires eligibility renewals only once a year, and in some states even a verbal statement regarding income is sufficient.
Alternatives to DPW’s current neglectful approach have been offered: What about following up with phone calls and multiple mailings to ensure that children weren’t improperly denied coverage? Or a moratorium on dropping kids from the program until DPW is certain it is adequately processing the renewals? Or at least halting six-month eligibility reviews of children with the most serious illnesses? All of these options are permitted under federal law.
Every proposal or idea has been rejected, and tens of thousands of kids remain virtually disappeared by the Corbett-Alexander approach to healthcare.
Read more from Greg Kaufmann's The Week in Poverty here.